Future directions in endometriosis research

Endometriosis is an important benign gynecologic disease that is pathologically defined by the ectopic presence of endometrial glands and stroma and is clinically associated with pelvic pain and infertility. The current knowledge of pathogenesis, pathophysiology of related infertility, and spontaneous evolution is still limited, although endometriosis has been described for many years. The diagnosis still can be made only by invasive tests (laparoscopy), and treatment either temporarily suppresses the disease (medical approach) or temporarily removes the disease (surgical excision). Recurrences of endometriosis after the stop of medical treatment or after surgery are common, especially in cases of moderate to severe endometriosis. Several reasons contribute to this state. First, at the time of diagnosis most patients have had endometriosis for an unknown period of time. It is impossible to undertake clinical research that would definitely determine the onset, etiology, or progression of the disease [1]. Second, an important reason for the lack of progress in endometriosis research is study design [2]: few studies have been carried out so far using adequate control groups. When symptomatic patients with endometriosis are compared to women with a normal pelvis, adenomyosis, leiomyomata, adhesions, or other pelvic pathologic conditions, two factors are usually studied in a combined way: